Alterations in leucocyte subsets and histomorphology in normal-appearing perilesional skin and early and chronic hidradenitis suppurativa lesions
Alterations in leucocyte subsets and histomorphology in normal-appearing perilesional skin and early and chronic hidradenitis suppurativa lesions
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DOI：
10.1111/j.1365-2133.2011.10643.x
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发表时间：
2012-01-01
影响因子：
10.3
通讯作者：
Prens, E. P.
中科院分区：
文献类型：
--
作者：
van der Zee, H. H.;de Ruiter, L.;Prens, E. P.
目的了解化脓性汗腺炎(HS)皮损周围正常皮肤、早期和慢性HS皮损的组织学改变和白细胞亚群。方法采用原位免疫组织化学方法检测8例皮损周围皮肤、6例早期和10例慢性化脓性汗腺炎皮损以及4例健康供者皮肤标本。结果皮损周围皮肤表现为轻度银屑病样增生和毛囊堵塞，类胰蛋白酶阳性的肥大细胞、CD3+T细胞、CD138+浆细胞和XIIIA+因子树突状细胞低水平涌入。HS早期以中性粒细胞脓肿形成为主，以巨噬细胞、单核细胞和树突状细胞为主。慢性病患者外周血中CD20+、CD79a+B细胞和CD138+浆细胞比例明显升高。与早期病变一样，在真皮和巨细胞内可检测到游离角蛋白纤维。真皮中可见单个脱落的角质形成细胞和滤泡上皮束，后者频繁表达Ki67，提示活跃的增殖。结论正常的皮损周围皮肤中已存在银屑病样增生、滤泡堵塞和低级别白细胞浸润。真皮中的角蛋白纤维与临床疾病有关。早期病变的特点是中性粒细胞脓肿的形成和组织细胞的涌入，而慢性病变主要是B细胞和浆细胞在假性滤泡中的扩张。滤泡上皮束的增殖可能导致瘘管的形成。肥大细胞在HS的各个阶段都有增加，包括皮损周围皮肤。
Background Current insight into the histopathological course of events during disease progression in hidradenitis suppurativa (HS) is fragmentary.Objectives To identify histological alterations and leucocyte subsets in normal-appearing perilesional skin, and early and chronic HS lesions.Methods In this observational study we examined eight perilesional skin samples, and six early and 10 chronic prototypic HS lesions, as well as skin samples from four healthy donors using in situ immunostaining.Results Perilesional skin showed mild psoriasiform hyperplasia and follicular plugging as well as a low-grade influx of tryptase-positive mast cells, CD3+ T cells, CD138+ plasma cells and factor XIIIa+ dendritic cells. In early HS lesions, neutrophilic abscess formation and influx of mainly macrophages, monocytes and dendritic cells predominated. In chronic disease, the infiltrate expanded with markedly increased frequencies of CD20+ and CD79a+ B cells and CD138+ plasma cells. As in early lesions, free keratin fibres were detected in the dermis and within giant cells. Single detached keratinocytes and strands of follicular epithelium were observed in the dermis, the latter frequently expressing Ki67, indicative of active proliferation.Conclusions Psoriasiform hyperplasia, follicular plugging and low-grade leucocytic infiltration are already present in normal-appearing perilesional skin. Keratin fibres in the dermis are associated with clinical disease. Early lesions are characterized by neutrophilic abscess formation and influx of mainly histiocytes, and chronic lesions mainly by expansion of B cells and plasma cells in 'pseudo' follicles. Proliferating strands of follicular epithelium may initiate fistula formation. Mast cells are increased in all stages of HS including perilesional skin.